04/14/24 - Amanda Singer
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Anne Keala Kelly:Heartfelt greetings and welcome. I shake your hand with good feelings in my heart, and the whole world is a beautiful day. It's good for all of us to be here and to let the people hear your voice respectfully and to celebrate life together. This is First Voices Radio coming to you this week from the illegally occupied Hawaiian Kingdom known to most as the 50th state, Hawaii. I'm Ann Kealakeli sitting in this week for your host Tiokasin GHOSTHorse.
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Anne Keala Kelly:This week for the entire hour we are discussing the terrifying up tick in syphilis infections and congenital syphilis cases in Indian country. This is a problem throughout the US, and it is hitting Indian country the hardest. Just to give you some background, national syphilis rates rose to a 70 year high between 2018 and 2022. The 2022 stats are the most recent CDC numbers, and we're in the midst of a penicillin shortage, which is the go to drug for treating syphilis except in cases of people who are allergic to penicillin. The rate of infection in 2022 was already 10 times higher than the decade before.
Anne Keala Kelly:And cases in newborn babies was up 183%. Congenital syphilis can mean death or severe health consequences for babies born to mothers who are oftentimes asymptomatic and because they lack prenatal care, unaware that they're infected. Coming up, a conversation with Amanda Singer, the executive director of the Navajo Breastfeeding Coalition, Dinah Dula Collective. But first, let's have a listen to a song by Navajo singer songwriter, Sharon Burch. It's called Little 1 from her album Yazzie Girl.
Sharon Burch:What shall I sing for you? Little baby. My, and sleep to the cell of wine, all of wine. And cheap soon appear dancing in your singing. My lullaby, my
Anne Keala Kelly:Amanda Singer, aloha, and welcome to First Voices Radio.
Amanda Singer:I'm happy to be here.
Anne Keala Kelly:There have been some stories in the media recently, and it's really alarming. Everybody at First Voices Radio is really grateful that you could join us today and talk about this incredibly difficult thing to talk about. And I'm not even sure why it's so difficult to talk about, Amanda. Help us understand the dramatic surge of syphilis in Indian country.
Amanda Singer:It could be a number of things. 1 of like, with my group, we are the Navajo Breastfeeding Coalition, and we have I believe in 2020, we expanded our doula collective, to a direct support program. And I think one of the things, like, the feedback that we've been receiving from the community and then just having general conversations, like, when we're tabling or having our regular, like, lactation support circles and whatnot, a lot of the feedback that we've been getting is, the lack of trust that our community has about going to the hospital. I think one of the things is just maybe they had maybe one bad situation that arise from, like, maybe one provider or maybe a nurse, and they particularly don't feel safe. You know, they end up not, like they hold off on their prenatal appointments.
Amanda Singer:And I know a lot of this discussion here is about the congenital syphilis rates.
Anne Keala Kelly:Right. Yeah. I know. A lot that's a big part of the story that's unfolding. But talk a little bit about the state of women's health and maternal health specifically in Navajo Nation.
Amanda Singer:It's a maternal health desert, essentially. And I know that when me and my team members you know, once we get referrals to do home visits, whether it's for a doula referral or a postpartum referral, or a lactation support referral, we'll make our way out to their home. And even even doing that, we're, like, traveling at times, like, maybe an hour and a half to 2 hours away just to get to these homes. And sometimes it's, like, just for a quick check-in in the event that, let's say, it's between appointments. There's very few of us.
Amanda Singer:There's probably about, I would say, 5 or 5 or 6 that are practicing on the Navajo Nation. For those who are not familiar with the size of the Navajo Nation, you're looking at about approximately 24 to 25000 square miles, which is essentially the same size as the state of West Virginia. Because there's only a few of us, sometimes we have to say, you know, no. You know, we we can't take up certain referrals in certain parts of the Navajo Nation. There's the other thing too that we're running into is, like, more people are hearing more about home birth.
Amanda Singer:It's really disheartening with that too, especially on the the Arizona side of the Navajo Nation. We really don't have access to, like, home birth midwives.
Anne Keala Kelly:And I see. Right.
Amanda Singer:So a lot
Anne Keala Kelly:of First of all, before you go any further, help people understand the difference between a doula and a midwife.
Amanda Singer:A midwife is they're the, essentially, the medical support person. They take care of they're responsible of for all the, medical needs of the patient. And and for doula, we're nonmedical support and or breast support providers. And I know that some people have approached me from different parts of the Navajo Nation asking if I could be the one to catch their baby, you know, and the one, being there, conducting, like, home births and stuff. And I have to, make that distinction and let them know that I'm not a midwife, and I'm a doula.
Amanda Singer:I'm there for, like, emotional, spiritual support and also their advocate and physical support. And, but as far as the midwife goes, the midwife is trained to do more of the medical provisions. And then in the event that the patient needs to be transferred, the midwife would be the one to make that call. One of the the things that we've been doing up here is just doing a lot of education around that.
Anne Keala Kelly:A few months back, there was there was some reporting about not just the national syphilis issue where rates are just skyrocketing, but the shortage of penicillin. That's typically the medicine that's applied unless the person has an allergy. So when you're encountering this or when a midwife is encountering a woman who is infected, can you give her a shot, or do they have to go take that 2 hour drive into town to the hospital? What do they have to do to get treated?
Amanda Singer:The home birth midwives that I've worked with in the past, normally, they do, they take them on a little, you know, early on in their prenatal period. They make sure, you know, that they have a really good health throughout their pregnancy in order for them to birth at home. If they start seeing some concern regarding, the prenatal individual or the pregnant individual's health, they start to become a candidate to for a hospital transfer. And I know with the home birth midwives, they they essentially work with certain labs, and they, you know, capture the labs. And I'm pretty sure, like, with, I know CNMs, and I know I think in New Mexico, they're working on, allowing the licensed midwives to have the power to prescribe, or they can refer them to get, like, a syphilis shot or a penicillin shot.
Anne Keala Kelly:Let's circle back to the congenital syphilis issue. Why is that so much higher in Indian country? You're saying that's because they're not getting in there for prenatal care? Is that basically it? Or or are there more natives that are getting infected?
Anne Keala Kelly:Like, what's the
Amanda Singer:It's a number of things, like, what I'm seeing as a community member. One thing I would like to bring out is that there are individuals in their community who are, specifically say that they're, I guess, you can say, quote, unquote, straight or CIS. And then what happens is, like, especially with, some of the males in our community, they may end up, like, having affairs with other men, but nobody really knows until it comes up in their partners. Like, maybe they they the the partner may start showing symptoms or the partner may get pregnant and, may not realize they were they were infected by syphilis. And I think a lot of people are aware of that is that fact that there's, like, a lot of unprotected sex happening.
Amanda Singer:Again, that circling back around to some of our pregnant relatives, you know, they don't Yeah. There there's been a number that I've been aware of to where they know that they're pregnant, but they really don't go to their prenatal appointments. And then they normally show up at the hospital until they're, like, in active labor. Oh, wow. Yeah.
Amanda Singer:Usually, by that time, it's a little too late. And so that's why we're trying to figure out how we can make it, you know, home births a little bit more accessible because individuals may or, you know, the community may have a little bit more trust with, like, these home birth midwives, which can essentially be certified nurse midwives, licensed midwives, or certified professional midwives.
Anne Keala Kelly:What are what's kind of the age range of what's is it women of all ages, or is it mostly younger women? What's the age demographic?
Amanda Singer:Young to possibly, maybe into their all the way up into their thirties, probably teen to their thirties.
Anne Keala Kelly:Well, is syphilis just something a person just can have and not know for a long time? Is that what's going on? They're just not aware that they have it.
Amanda Singer:Maybe they're not you know, maybe they're asymptomatic and they don't realize it, or maybe there's certain things that are happening with their body and they're really not aware or sure of it. That second stage of syphilis, I believe, it develop you can develop a rash. And sometimes, you know, they may feel like it's probably because of an allergy they may have. I guess you can say maybe they're in denial. Maybe they just think you know, maybe they think they're okay when in fact they really don't know or they really don't wanna go into the hospital.
Amanda Singer:Because if they go into the hospital or they get tested by an organization that may do free STD, STI testing, that's gonna make them face reality. Plus, we have a high substance use rate as well.
Anne Keala Kelly:Are they running the risk of possibly losing their child
Amanda Singer:Yes.
Anne Keala Kelly:To CPS?
Amanda Singer:Yeah. They have a risk of losing a child, and also the child has a risk of neurological problems.
Anne Keala Kelly:Well, let's talk about that. So what happens when a woman who has this infection gives birth? What happens to the baby? What's the danger here?
Amanda Singer:Well, the baby is gonna be sick, or it could be a stillbirth. Again, I think, you know, there's, there's different ways they screen for, different, whether it's viral or bacterial infections. But I know that it's a really it's just it's just an ugly ugly disease. And I think there's just not, there's a lot of like, back here on Navajo, when you talk about it openly, a lot of people don't wanna hear about it when it comes to talking about, STDs and STIs and how it can impact, an unborn child. You know, that's the one thing that really it's really disheartening to see that, like, some of the I mean, I've seen, like, the, Navajo Health Education program and then also, like, the, Navajo HIV prevention program.
Amanda Singer:And then there's even some grassroots organizations that have these tests on hand, and they continue you know, they they they offer these free tests. But a lot of the times, you see a lot of the community members just kind of walking by and avoiding avoiding it.
Anne Keala Kelly:Is that a cultural block? I mean, I don't know if I would call that a cultural block or just political, or what is the hesitation to reach out for help?
Amanda Singer:I think a lot of it, like, part of it is stubbornness, but then also, again, there's that whole issue of not trusting the hospital for a lot you know, for different various reasons. And I also think that, there's a teaching in our Navajo way where we talk about thinking of all the good things and, you know, having a pow a positive outcome from thinking positively. And I think that's why a lot of people think, okay. Well, if I start looking at that, then I might end up having that. You know, if I start reading information about STIs or STDs, you know, maybe that's, or they're they're gonna think that they're kind of, I guess, you can say, jinxing themselves per se, like, quote, unquote jinxing themselves and their health.
Amanda Singer:But I that's one thing. Like, I I've even shared information on my social media platforms. And a lot of the times, like, some of my regular posts like, I try to post a lot of humorous posts. I get a huge response. And then, like, for me, like, when I post pictures of myself, on my personal page and then also pictures of my team on our, Coalition Facebook page, there's a lot of feedback happening, a lot of interaction.
Amanda Singer:But when I post specific information about the whole the the the situation around syphilis and then their increased rates and then also the the the scary, rise of congenital syphilis cases and then even sharing information about maternal mortality in indigenous communities and also the, drastic increase in infant mortality in indigenous communities. So, you know, when I when I post specifics like that, know that I really don't have any interest. Like, everybody just decides to go quiet. And I think that's the problem is that nobody's talking about it. Nobody's openly talking about it.
Amanda Singer:A lot of people really just wanna ignore it because it's bad. But then, I will when, like, when I do post stuff like that, especially around infant mortality, a lot of these people too are individuals who are, like, really vouch about being, pro life. But when people start saying pro life, they have to realize it means a lot more than what they think. They just think roversively. But I think if you're gonna be pro life, you have to also be out there advocating in every aspect of the unborn's future.
Amanda Singer:You do your best to protect their life that they have a healthy outcome when they're born as opposed to having something that could, you when they're born as opposed to having something that could either debilitate them for the rest of their life or literally kill them.
Anne Keala Kelly:Absolutely. I agree with you completely. Let me ask you this. In terms of Indian Health Services, how are they able to interact with women who are not seeking prenatal care early on?
Amanda Singer:Right now, I know I've seen different various campaigns from I Indian Health Service. Like, they do try to do their best at tabling in the community and sharing information about trying to increase their or or spread the awareness of the importance of receiving prenatal care. And I've seen different campaigns go out there because I know this is something that's been consistent though. Like, even before the the whole situation around congenital syphilis, there's, like, years that where where I've been hearing about women not going in to get their prenatal care until, like, the very last minute, like when they're laboring is when they'll finally make their way to the hospital. But I've seen different campaigns and then also I've seen other organizations that work within perinatal health, maternal health, infant health, what have you, that have been doing their own campaigns and really trying to emphasize why it's important to get prenatal care.
Anne Keala Kelly:Have you yourself in your work encountered a birth taking place with an infected mother?
Amanda Singer:No. Not not myself or not any of our doulas. The only one the only group that I think that would come close to that would be the UNM birth companion program. The reason why I'm saying that is because usually within our team, we normally take on prenatals pretty early on, like, maybe at the end of the 1st trimester to the sec or early 2nd trimester, and we just make sure that they are receiving prenatal care, whether it's by, you know, a birth center, a home birth midwife, or the hospital. And so that there and then we also make sure that, you know, we're that we're that person in the back saying, just make sure, you know, this is as important.
Amanda Singer:We're educating them on why it's important and why they need to get their labs done and everything. So we're like, would they hear it from their, provider, whether it's a midwife, home birth midwife, or maybe even, an obstetrician? They're hearing it from them, but then also when they see us, they're hearing it again from us.
Anne Keala Kelly:That's a really great program that you have going then. So you it's important, I think, for people to look into what it is you offer, through the collective for pregnant women.
Amanda Singer:The reason why I mentioned the UNM birth companion program is usually any of their patients who may request a doula at their birth, they can get a doula and or a birth companion there, like, within about a few hours after the request has been made, and then they help them through the birth. And I think from that, you know, I think that program may have more of a general sense of what that looks like. Because for us, normally, even with any late referrals and sometimes, like, if my schedule is open to it, like, the the late referrals, I'll get them, like, maybe between 34 to 30 week 36 weeks gestation, and I'll start asking them questions. And then, normally, I end up showing up with them, like, maybe for 1 or 2, prenatal appointments in their 3rd trimester. So even at that at that, you know, we are aware of, by that time, we have a general awareness of how their health is doing, and are aware of, like, the type of tests that they have, you know, gotten done.
Amanda Singer:And so by the time the birth outcome, you know, happens, we are aware that they, have been you know, went through the STD, STI screening. And if they did have 1, they were treated for it. And so by the time the birth happens, you know, the baby usually comes out without an STD or STI.
Anne Keala Kelly:Let's take a short break here and let Sharon Birch bless us with another one of her gorgeous songs. This one is called Grandmother's Ways from her album Touch the Sweet Earth. Welcome back to First Voices Radio and my conversation with Amanda Singer from the Navajo Breastfeeding Coalition to Na Doula Collective. I mean, the first thing I thought when I heard about this was this is the like, a totally preventable disease.
Amanda Singer:Exactly. It is 100% preventable. And there's just so many things out there that, like, contribute to your factors, I guess, you can say to this whole issue. And then just people like like like I was saying, it's just so what I'm seeing is just a lot of ignorance. People don't wanna hear about STDs or STIs for whatever reason.
Amanda Singer:But then again, you know, it's real. It's out there. It's it's essentially killing our babies. And, when you look at the infant mortality rates, especially among AIAN communities, you'll see that there's even a drastic increase in that just more recently. That's just a scary the scary thing for me too, and it's, like, trying to figure out what's going on.
Amanda Singer:And I think a lot of the tribal and federal state governments, and then also nonprofit organizations, grassroots organizations who are already involved in this work, I think we just need to put our heads together and figure out what we need to do.
Anne Keala Kelly:Also, I think that there's the ignorance factor and the fear factor, but there's also the communication factor. I know native women love their babies just like non native women. So it isn't that. It's something else and these things have to be solved because this is an unacceptable, preventable crisis. And and I know that it's not just happening to natives, but it's hitting natives the hardest.
Amanda Singer:Yeah. Just like everything else. You know? Yeah. Even during COVID, it was mainly natives that were getting hit particularly hard by that.
Anne Keala Kelly:I feel like anybody of Internet age is inundated with stuff that makes them more vulnerable to sexual anything.
Amanda Singer:Mhmm.
Anne Keala Kelly:Am I are you seeing that too or or am I just that's my imagination.
Amanda Singer:I'm seeing that too. I mean, I'm seeing that here. And but I think it's like what they see on social media, on TV. Yeah. I'm seeing that here too, and it's kind of like I don't know what it is.
Amanda Singer:I don't know if it's because, like, think you know, talking as, a native person, specifically, Dine, I know that I was brought up on some really harsh teachings. Mhmm. And and I think the I think maybe there's, like, a a cultural difference there because what I mean not cultural, but difference. But I think there's a The language barrier, I think, has a lot to do with it too because I know a lot of the teachings I was raised in, I heard and learned it, with our our Navajo language. It was always Navajo with my family where when they would lecture entirely Navajo.
Amanda Singer:And so, like, when you try to translate as much as you possibly can in English, you really miss the main core points of the translation in Navajo. And then, like, I think that, you know, a lot of people are really stern, like, the older generation, and a lot of people think that they're mean. But I think that's how they come across because our language is I think we're just straight to the point, like, hit the nail on the head no matter how harsh it how how harsh it may come out. Mhmm. And I think, the younger generation, I think, is missing that factor, especially the ones that don't know their language.
Anne Keala Kelly:What are the three most important things that you want people to know about this dramatic rise in syphilis?
Amanda Singer:Well, 1, to use protection because this is completely preventable. I don't even know of any health care, you know, systems that don't give free condoms. You, you know, you have condoms to at least decrease your risk of getting or transferring STD or STI to someone. And then 2, there needs to be more of a campaign. The tribal health programs, hospitals, and then also community orgs like the Navajo Breastfeeding Coalition, we really need to work together, And I think we have to really partner together to help spread the where you know, awareness about it and talk more openly about it, instead of, you know, just tiptoeing around and not really speaking openly about it because it's affecting our babies.
Amanda Singer:It's affecting our our future generation, and I think that should be enough to move forward with you know, as a community, as, you know, in partnership collectively. That, I guess, for for this, it's like a call to Indian Health Service or tribal health programs, 638 tribal hospitals, and then any community orgs or, grassroots organizations who are working around, you know, perinatal, maternal, or infant health and or infant health. You know, we really need to come together as a team unite and then also, you know, to spread awareness and be all on the same page as we help each other. And then number 3, the maternal health deserts. We need to also create other safe options for indigenous communities.
Amanda Singer:I mean, there's a lot of negative, I guess, rhetoric out there about home births, and a lot of people think they're unsafe. But as long as there's a midwife there and she's there making sure that their her her patient's health is good all the way through the pregnancy to have a home birth and then also making sure that, there's a way in the event that there needs to be a transfer, that there's a health care system close enough to make that transfer. I think indigenous communities also just need that choice, not just having to focus on the hospital, but they can like, maybe they can have birth centers or maternal or perinatal health hubs out there in the the most rural parts of the Navajo Nation where that health hub could actually have, whether it's certified nurse midwives or licensed midwives or certified professional midwives, and even having, like, birth support workers, you know, like doulas, working in that that health hub and being able to go out and do home visits to the community and then taking all of their their testing kits and stuff like the like that with them just so that they can, keep up on that.
Amanda Singer:Because right now, it's just it's really, sad that we still have community members that have to travel, like, maybe an hour, an hour, half to 2 hours, maybe even 3 hours away to just make a regular hospital appointment. And sometimes they have a local hospital in their community, but they prefer to get treatment at a different hospital. I mean, I know Fort Defiance or Teton Medical Center, a lot of their patients are not just generally within the community. I mean, I know of people who travel all the way from, let's say, Greenwood, Arizona, or Delcon just to receive their patient, you know, their their patient care here. And those communities are, like, an hour to an hour and a half away from here.
Amanda Singer:If there was, like, maternal health or perinatal health hubs, that gives people an option to be able to receive, like, their care. And then if there is something that's a little bit more urgent or more serious, then these individuals would catch it, meaning the, the midwives that work there, or maybe they'll have, like, perinatal home visitors. I think they may be able to catch certain things out there before it before it runs its course, meaning, like, viral infections, bacterial infections, or maybe even, like, domestic that family or their their patient to acquire care. And I think that's the one thing that I'm seeing with the the Indian health services and then the tribal hospitals out here is that they do have, like, public health nurses and then nurses within, you know, their community health program that go out to a certain range. You know?
Amanda Singer:They're able to do home visits, but they only can go so far, and they can't go out, you know, further. Maybe creating little hubs like that would actually help and decrease a lot of, not just the syphilis rate, but let's say HIV rates and any STD or STIs out there, but also increase our community members, our our pregnant relatives, increase their, access to prenatal exams, increase their access to, postpartum exams. And I think that's one thing that the key thing that's missing is meeting the community at where they're at. I know, like, a few years ago, when the with within the pandemic, we did help support some of our clients within the home birth. But when I've seen that, home birth, midwifery team, what they were doing was that they were leaving their office or their birth center and then traveling out to this person's home, and they would do their entire prenatal exam within their their patient's home.
Amanda Singer:And then, like, they're they they alternated the in person and also the virtual visit. So even during the virtual visit, what they did was they incorporated, the fam the the dad, the partner to be there. And they they taught their the partner or the main support person there at home how to do, like, blood pressure checks. They taught them how to properly take weight, their prenatal weight, and then they also taught them how to do their, you know, their little urine test. So when that happened, you know, I was seeing a lot of inclusion of the partner, but, also, they were able to do, like, some of their labs there.
Amanda Singer:And then, you know, they do what they need to to make sure that it was safe and still good when they transported it back to the different labs that they were working with.
Anne Keala Kelly:So it's really about empowering them where they are.
Amanda Singer:Yes. That's what that's. I think that is what one of the main missing keys are within each indigenous community or native community with within the USA, you know, within our country. And I think that's the key like, the key factor of it is because what I've seen with the home birth midwives that I worked with, they go out to meet their patients. They go to their home.
Amanda Singer:They get to know the family. They gain the family's trust. And then, you know, I've seen a lot of really good interaction. And then I've also seen where they had no other choice, like, at the end stage of pregnancy if they have concerns of their patient's health. I've seen them transfer them to the local hospital there's, like, 3 different ones.
Amanda Singer:There's a certified nurse midwife. There is licensed midwives and certified professional midwives. And how I've seen them work is really beautiful, but I just really wish that every community, indigenous community, helped our Navajo relatives who were able to receive that type of care.
Anne Keala Kelly:Well, I have 2 questions or two and a half questions. The half question is where is here? When you say here, where where are you?
Amanda Singer:I'm actually talking to you from Fort Defiance, Arizona. And the Navajo breastfeeding coalition, we do our best to cover the entirety of the Navajo Nation. Just like I said, there's only, I think, maybe 5 or 6 of us back here. And we will also have, a few direct support providers, like, in the Phoenix area and also Albuquerque.
Anne Keala Kelly:And when you referenced the pandemic just now, just if you can briefly explain how that success with what the Navajo Nation was able to do during the pandemic, how that can influence creating a successful outcome here with regard to congenital syphilis.
Amanda Singer:I think it's just, again, back to what you had mentioned earlier, just empowering the community and also, like, even with and I I don't wanna talk, like, negatively about the hospital because they are there for a reason. And there's, like, several, good providers that I've come across in different, Indian health service hospitals and tribal hospitals. But I also believe that a lot of our community members have to are still dealing and healing from historical trauma. So when they go into the hospital, they a lot of them don't know how to, or they don't want to or maybe they really don't know how to advocate for themselves. And I think that's one thing too is just creating the partnerships that we had, like, during the pandemic to make sure and ensure that some of these families who were afraid to go to the hospital because of COVID, we were able to, provide, like, we you know, help with referrals and resources to these midwives who actually came out and helped with births.
Amanda Singer:You know? And we were able to help uplift their group because of what we were seeing. I think if that could be incorporated in different, you know, indigenous communities, and then also the health care health care systems actually recognizing that home birth can be safe and that people who like the home birth midwives that do help it, you know, they're a tool that they should be using. There's still a lot of taboo around home births, and people forget that our ancestors were doing that. You know, they had their own indigenous midwife, and then they also had their herbs and their medicines.
Amanda Singer:And then that's why we're still here. And it kind of I just I don't know. I I guess, to me, I'm just like when people say I don't think it's safe, you know, and I've I've had to come in with families where previous clients were telling me so and so in my family feel that home birth is unsafe. And then they would ask me to come in and, talk with the family sometimes, and I would explain to them the process and stuff like that and what I've experienced with home homebirth, midwife, reteens. And and I think just the one thing that gives them a peace of mind is I also let them know that they're not stubborn.
Amanda Singer:You know? If they see a need for your relative to be transferred for a higher tier or higher level care, then they'll make sure that this person your your relative is transferred. They're not just they're not gonna chance it with the home birth.
Anne Keala Kelly:I'm thinking 2 things from what you're saying. Since time immemorial, women have given birth at home. So it's like talking about a tradition versus an industry in terms of how people think. Yeah. And I really
Amanda Singer:you know, what we do, and that our priority is that our community is safe.
Anne Keala Kelly:Well, the other thing that I thought of when you were talking is the Navajo Nation is its own nation. I mean, it's not the American culture. They're foreign. The American system or or way of dealing with pregnant native women is it's somewhat foreign, isn't it? I mean, it sounds like it's still kinda foreign to people there.
Amanda Singer:Yeah. It yes. Yes, somewhat. Because I think the other downside too that I see with, our tribal hospitals and Indian Health Service is that there's such a high turnover rate. And then some providers are only here for a short time, and then they move on.
Amanda Singer:And I think that's, like, one of the things that, for my own family, you know, sometimes, like, with the with when they with their primary care provider, I've also known, like, them having to change them out consistently because that primary their former primary care care provider may have been there for, for, like, anywhere from 6 months to a year, and then they move, and then they have to get used to another primary care provider. And sometimes I think, the community just gets tired of that because even though they have to change primary care providers, that also means that they have to go through a whole round and battery of testing again, which they may have just done a few months back with their previous PCP. Or I hear a lot of talk about that in the community and within even in my family, You know, they're always saying, like, my PCP left, and now I'm assigned to another one, and then it's like they have to start a whole new relationship with this primary care provider. That that in itself is not something that just happens on Navajo, but it more than likely is happening in other indigenous communities.
Amanda Singer:You build trust with 1 and then that person leaves, and then then you have to work on building trust again.
Anne Keala Kelly:The system is not native friendly is what I hear you saying.
Amanda Singer:No. It's not native friendly. I'm I'm just really I'm glad that more recently too, like, our local hospital here at Teotihuahua Medical Center, and then I think it was Northern Navajo Medical Center, and then Gallup Indian Medical Center, They've been more open about hearing more Navajo cultural teachings around birth. And the interesting thing about Teotihuahua Medical Center, when I met with them, a few months back, they were beginning to think, like, how can we incorporate all those practices into our l and d, our labor and delivery floor? And I'm glad that, you know, they're beginning to think about that, but they haven't reached out back to me to to let me know if they're actually incorporating or working with Navajo practitioners that, work within the hospital.
Amanda Singer:But it would be interesting to find out if they are. They still honor, of course, they honor and respect traditional practices in general when when you're gonna do something like bring in a medicine person onto, you know, to to to do a prayer on a patient. But it would be nice to know, like, what other things they're incorporating within, you know, birth and pregnancy and postpartum.
Anne Keala Kelly:Well, Amanda, where can people find information about what you do, and, also, where can they find out more about how to help solve this problem?
Amanda Singer:Well, we do have a Facebook page. It's called, it you can find it under Navajo Breastfeeding Coalition. And then also you can email me at, denae nation breastfeeding@gmaildot com. And, for any information, like, for anybody who wants to maybe donate to our cause, But all of our donations, we use back into our coalition, to do our community work and also to, just to help our our our prenatal, you know, birthing, postpartum relative relatives, and then we also help around lactation support. And we are beginning to venture into, like, some policy work.
Amanda Singer:So there's a lot of things that we are involved in, and, all of our money does go into helping support the different projects that we're that we're involved in.
Anne Keala Kelly:Really, it's great work that you folks are doing. And one last question. Would you encourage people to contact their own tribal health services just to get more information so that they're informed on this issue?
Amanda Singer:Yes. For the Navajo Nation, you you can look at any, Navajo area Indian Health Services. You can Google Indian Health Service, and then you'll find, like, the contact information all in there. And then as well as, Seattle Medical Center, they have their own website too if you wanna know more information. And then I believe you can even like, I know the Navajo Nation, we have our own department of health, which is Navajo Department of Health.
Amanda Singer:I believe that you can even, reach out to them to access more information. Or you can just reach out to me, and then I can connect you with whoever you want to whoever you need to be connected with.
Anne Keala Kelly:Well, thank you so much for coming on First Voices Radio and and helping us understand this really complicated but solvable crisis. And, I hope we have you on the show again not too long from now to update us on the success of of all the changes that are gonna be taking place, hopefully.
Amanda Singer:Yeah. And, just thank you, Just basically meaning a huge thank you for, inviting me to be here. You know, it was a good good discussion.
Anne Keala Kelly:Once again, for sharing this sacred time with me. We close now with The Peacemaker is Born from the late Joanne Shenandoah's epic 2000 album, Peacemaker's Journey, which is about Kanalahawe, the great peacemaker, who introduced the great law of peace to the Haudenosaunee people, which according to oral tradition appeared as early as AD 1142. The Haudenosaunee among millions of native peoples residing in all regions of the North American continent pre European invasion and colonization were the first to create a sophisticated modern form of governing. Political power was held in balance by an elaborate system of checks and a view of individual freedom. And this was 100 of years before the US and the United Nations came into existence.
Anne Keala Kelly:Pray for peace, demand peace, don't settle for anything less than peace. Until next time, be righteous.
